4 - 6 - Video 3.6 Policy Issues (6 58)

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• Index
• 4 - 10 - Pros and cons of 'labeling ', Childbirth A Global Perspective
• 4 - 7 - Oral language impairment, Childbirth A Global Perspective
• 4 - 11 - Week 3 Round-up, Childbirth A Global Perspective
• 5 - 5 - Subject specific science, Childbirth A Global Perspective
• 4 - 9 - Positive aspects, Childbirth A Global Perspective
• 4 - 5 - Maths (dyscalculia), Childbirth A Global Perspective
• 4 - 8 - Psychological effects, Childbirth A Global Perspective
• 5 - 4 - General principles, Childbirth A Global Perspective
• 5 - 3 - Reports on reading, Childbirth A Global Perspective
• 4 - 6 - Dyspraxia, Childbirth A Global Perspective
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4 - 6 - Video 3.6 Policy Issues (6 58), Childbirth A Global Perspective

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The last section of thispresentation pertains topolicy issues regarding task shifting,and their impact on maternal andnewborn services,especially in sub Saharan Africa.As previously noted, beginning withthe new millennium, healthcare, cadres,roles and responsibilities in lowincome countries have changed andexpanded due to the variety andnumber of global health initiatives,accompanied by recent advances indisease prevention and control.Mid-level practitioners such as nurses,midwives, non physicians, clinicians,are now trained to assume new programresponsibilities as a result of trainingsorganized and supported by outside donors.Additionally, a numberof ministries of health,having benefited from outside fundingto launch new initiatives in malaria,tuberculosis, maternal and child health,HIV/AIDS, currently endorse expandedtask-shifted roles previously consideredthe exclusive purview of medical doctors.However, because these roleshave evolved informally,usually at the facility or program level,there's frequently an absence ofcorresponding laws, regulations, orofficial policies to support the newlyacquired duties and responsibilities.Although global normative bodies haveendorsed expanded scopes of practice fornon-physicians, includingcommunity health workers, andhave developed specific guidancesupporting their implementation,policy challenges arise whenofficial regulations regarding taskshifting lag behind program effortsto scale up a health initiative.This asymmetric state of affairs isespecially notable within HIV care andtreatment services delivered inmaternal and child health settings.For example, until recently PMPCT Programsconsisted of anti-retroviralregimens that focused on preventingHIV transmission to the newborn.Recently this protocol has been replacedwith a more comprehensive regimen thatincorporates maternal HIV care andHIV prevention for the infant.Current WHO guidelines regarding PMTCTservices recommend the provisionof lifelong ART to all pregnant andbreastfeeding women infected with HIV,regardless of their immune status orclinical stage of the disease.This newer focus on the mother,also referred to as option B+ is based onthe latest scientific understanding ofHIV transmission, and was introduced asa means to simplify the diagnosis andtreatment of the disease among pregnantwomen, while simultaneously reducingmother-to-child viral transmission.While this latest protocol hasthe potential to simplify the work ofhealthcare providers,by reducing diagnostic complexity andpromoting service integrationbetween PMTCT and ART, it has alsoincreased task shifted responsibilitiesamong lid, mid-level providers.A number of ministries of healthhave adopted option B+ services intheir maternal and child health clinics,and have informally accepted taskshifted practices,even though their national laws andregulatory policies restrict diagnosingand prescribing ART to medical doctors.In some instances, these restrictionsare supported by the medicalprofession councils, who view taskshifting as an erosion of their authority.In other instances,pharmacy boards responsible fordetermining which drugs can beprescribed by which health provider,are the barrier to developing andadvancing national task shifted policies.Additionally, there are situationsof unintentional oversight,where lack of awareness andcommunication between national HIVprograms and the respective policy andlegal governmental units have resultedin an absence of updated policies,making health workers vulnerable to legal,professional, and ethical violations.In a recent East, Central, and SouthernAfrica survey of nurse-Initiated andmanaged ART or NIMART, Zuber, et alnoted in the Journal of the Associationof Nurses in AIDS Care, that amongthe countries they surveyed, the lowestART coverage was found within thosecountries where NIMART was not practiced.The survey, which was conducted in 2012,queried senior nursingleadership teams about the extent towhich NIMART was widely practiced andauthorized in policy, regulation,and pre-service education, that is,education provided prior toprofessional entry into practice.Their findings further noted that whileNIMART may have been practiced andauthorized at local facilities,the practice lackedregulatory reinforcement andincorporation into pre-service training.In addition to national laws andgovernment policysupporting task shifting,expanded non-physician roles also requireprofessional regulatory board endorsement.Professional regulatory counselsthat govern the practices of nurses,midwives and non-physician cliniciansneed to formally acknowledge expandedpractices and revise their respectiveprofessional boundaries orscopes of practice, and communicatethese changes to their constituency andacademic training institutions andmonitor the task shifted duties, so as toassure patient quality of care, whilesupporting their constituents' standing.As you can see, introducing taskshifted roles into health services,requires a health systems approach,that incorporates evidence based andformalized program guidance,supportive legal policies and officialrecognition by professional regulatorycouncils regarding approved practices.Failure to include these componentswhen introducing task shifting tohealth service delivery can delayofficial endorsement of the practice,jeopardize program implementation andplace health care providers at risk ofviolating legal oraccepted professional practices.In summary this lecture introducedthe concepts of task shifting andtask sharing andexplained the difference between the two.We also reviewed the scientificliterature in order toappreciate the evidence base forthis approach andrecognize trends within maternal,newborn health, and HIV programs.Lastly policy considerations regardingcash shifting were presented soas to acquaint you, a current orfuture global health practitioner,with non clinical issues needingattention, in order to affect change andensure support and successfulimplementation of task shifted practices.The preceding program iscopyrighted by Emory University. 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